The Outreach Specialist, Clinical Quality will provide clinical guidance, education and support to members with preventive and chronic care services; specifically assisting those members with multiple co-morbidities and complex health status in order to improve health outcomes. The Outreach Specialist will assist the Member Outreach nonclinical team with members in need of clinical assessment and intervention. The Outreach Specialist will assist with the development of telephone scripts for education and barrier analyses and will conduct barrier analysis calls as indicated. This position will also assist in the development and gathering of clinical metrics for the unit, and will work with other members of the Clinical Quality team to help improve HEDIS, STARS and QARR scores for all lines of business
• This position is located at 100 Church Street, New York
- Provides clinical support and guidance to approximately 8-10 nonclinical staff members (outreach coordinators). Responds to questions raised during member outreach calls and troubleshoots/intervenes as needed.
- Conducts telephonic outreach to certain member populations with significant health issues and/or co-morbidities to help improve access to care and the overall rates of required services.
- Advocates, informs, and educates members on services, self-management techniques, and health benefits related to HEDIS services.
- Collaborates with providers, community-based services, and internal departments to coordinate care and assist members with adequate access to care
- Assists with the development of barrier analysis call scripts to address measures/conditions where HEDIS/QARR/STARS rates and health outcomes are not as expected.
- Conducts barrier analysis calls to specific member populations to determine any systemic reasons for low performance. Assists in the development of interventions to address identified barriers.
- Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures and follows up as needed
- Participates in Quality Management Program by identifying improvement opportunities related to HEDIS/QARR/STARS, including performance and through documentation of clinical services.
- Assists in supplying metric data for quality studies and HEDIS planning.
- Contributes to departmental and corporate goals through ongoing execution of care gap closures and associated member health outcomes improvement.
- Additional duties as assigned
- NYS licensed LPN
- 2 years clinical experience
- Bilingual (English/Spanish) OR (English/Mandarin or Cantonese)
- Experience with HEDIS/Quality/QARR
- NYS licensed RN preferred with 2 years minimum clinical experience and/or 2 years minimum experience in an Outreach setting, Managed Care, Office Management or related field
- Strong interpersonal and assessment skills, especially the ability to relate well with seniors and families
- Excellent verbal and written communication skills required
- Knowledge and experience with the current community health practices for the frail adult population and cognitively impaired seniors
- Experience managing member information in a shared network environment using paperless database modules and archival systems
- Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
- Experience and knowledge of the relevant product lines
- Previous health education or case management experience
- Ability to work independently with minimal supervision in achievement of departmental goals for engagement and productivity
- Intermediate proficiency with Microsoft Outlook, Word and Excel (including ability to edit, search, sort and filter data)
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
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